Provider Demographics
NPI:1255003851
Name:MIAMI SHORES MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:MIAMI SHORES MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARIAS-URDANETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-206-8610
Mailing Address - Street 1:209 NE 95TH STE 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2745
Mailing Address - Country:US
Mailing Address - Phone:786-206-8610
Mailing Address - Fax:786-206-8612
Practice Address - Street 1:209 NE 95TH STE 4
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2745
Practice Address - Country:US
Practice Address - Phone:786-206-8610
Practice Address - Fax:786-206-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty